37D2308503 CLIA NUMBER - CLINIC AT 410 PLLC

Laboratory Demographics

  • CLIA Code: 37D2308503
  • Facility Name: CLINIC AT 410 PLLC
  • Facility Address: 410 HWY 70
    KINGSTON, OK
    ZIP 73439
  • Facility Phone: 580 565-9975
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: TRESSA MATCHEN
  • NPI Number: 1144065012
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 37D2308503
LAB Type Independent
Facility Name CLINIC AT 410 PLLC
Street 410 HWY 70
City KINGSTON
State OK
ZIP 73439
Phone 580 565-9975
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2024
Certificate Expiration Date 7/29/2026
Facility Type Independent
Lab Director TRESSA MATCHEN

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This page was last updated on: 9/29/2025